Smoke Alarm

Despite the well-known dangers of tobacco, more than a billion people worldwide still smoke cigarettes. On Thursday, in its first report on global tobacco use and control efforts, the World Health Organization helped shed light on why the number of smokers remains so high. Though tobacco is the world's leading preventable cause of death—killing an estimated 5.4 million people a year (more than tuberculosis, HIV/AIDS and malaria combined)—the WHO report found that, while 152 countries have pledged to implement recommended tobacco-control policies, only a handful have taken strong action already. Governments around the world still take in, on average, more than 500 times as much from tobacco taxes as they spend on tobacco control.

WHO—along with the Campaign for Tobacco-Free Kids, the U.S. Centers for Disease Control, the World Lung Foundation and Johns Hopkins University—is hoping to change that by promoting a new program it calls MPOWER, a package of six tobacco-control policies it is urging all governments to adopt. NEWSWEEK's Karen Springen discussed the plan with Jonathan Samet, chair of the department of epidemiology and director of the Institute for Global Tobacco Control at Johns Hopkins Bloomberg School of Public Health, and Heather Wipfli, project director of the Institute for Global Tobacco Control. Excerpts: 

NEWSWEEK: What should governments' role be in combating this public-health problem?
Heather Wipfli: First, monitor the epidemic within the country, know how many smoke. Second, protect people from exposure to second-hand smoke. Less than 5 percent of the world's population are protected by smoke-free regulations. The third action is to offer smoking cessation and treatment to those who are already addicted. The fourth point is that we need to warn world populations, including public service announcements and hard-hitting and large warning labels on all packaging for tobacco products. The fifth is to enforce bans on the advertising and promotion and sponsorship—breaking down the image that the tobacco industry promotes of being useful, sporty and modern. And finally, raise taxes as high as possible. Taxes are very effective, especially among the poor and the young. The funding from taxes can be used for a number of programs. Currently only about 5 percent of the world's population has a tax rate over 25 percent of the package price. There's plenty of room for developed and developing countries to raise taxes.

Jonathan Samet: In the United States, the federal tax is around 67 cents a pack. Federal taxes are in general a small proportion of taxes in the states, which can levy some of them up to almost $3 a pack. We've begun to tax cigarettes far more than before. It's recognized as a source of revenue. It does have public-health advantages. People are more likely to quit, and children are less likely to start.

Which countries are doing the best job?
Wipfli:Uruguay is the first country in the Americas to go completely smoke-free. Ireland, Scotland, France and Italy have gone smoke-free, everywhere, including restaurants and bars. A lot of countries have very large, graphic health warnings on packages, including in Thailand, Egypt, Uruguay, throughout the European Union. A number of other countries, including Malaysia, have increased their taxes. Thailand has very comprehensive tobacco-control laws, including strong bans on advertising. So does Poland. The United States is not the global leader.

Which countries have been resistant to implementing such policies?
Wipfli:Indonesia, Russia and the United States are among [them].